Week 3 Mid-Term

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West Coast University, Ontario *

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500

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Health Science

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Dec 6, 2023

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Running head: FINANCE AND ETHICS 1 Finance and Ethics Maria Ocampo West Coast University: MSNC 500 July 23, 2023

FINANCE AND ETHICS Finance and Ethics As Advanced Practical Nurses (APN), depending on the state and facility we work for, there are different policies and politics we must follow. Many times, APN’s are faced with ethical conflicts resulting from moral distress due to perceiving the policies and regulations as unfair. In the video, Practice and Principles Episode 3 (2023), the hospital staff are faced with an ethical dilemma regarding the discharge of a patient that suffered a stroke and must be discharged because her insurance no longer covers her stay. In the video a staff member decides the patient must discharge because the bed is needed for other critical patients, other staff is concerned regarding the patient not being physically ready to return home. The ethical issue in the video for medical staff is discharging a stroke patient without any rehabilitation, the patient needs long term rehabilitation or home rehabilitation services. To solve this ethical issue, the narrative ethics approach is more relevant to the scenario. According to Hamric & Hanson’s Advanced Practice Nursing , the narrative ethics approach “gathers views of all parties to provide more complete basis for moral justification,” in this video, there are several opinions from different medical staff members (Tracy et al, 2023, p., 352). With the narrative ethics approach, the different opinions from all the staff members can be analyzed. According to Application of Narrative in Medical Ethics (2019), in the medical system, the narrative approach uses other patients’ stories and experience to improve the health decisions made (Daryazadeh, p. 1). Other medical staff members have treated stroke patients and know their stories, therefore they’re decision to not discharge the patient because she isn’t physically ready is the correct decision. Evidenced-based interventions should be applied when making ethical decisions for positive outcomes. Medical staff should do research to provide interventions that have had 2

FINANCE AND ETHICS positive outcomes and go on to make the best decision for the patient this will lessen the moral distress. The main issue in the scenario is the conflict between two different points of view of the medical staff. One is discharging the patient because of her insurance coverage, adding to that the patient can acquire an infection from being in the hospital too long. The other medical staff are against discharging the patient because she isn’t physically ready to be on her own. My advocacy solution to this dilemma is to not discharge the patient until arrangements have been done for rehabilitation. This patient needs advocacy from the nurse and other interdisciplinary team to prevent her discharge. Discharging this patient is unsafe because she is not physically ready, the patient suffered a stroke and needs long term rehabilitation to become as independent as she can. According to Rehab therapy after a stroke ( 2023), a stroke patient must have rehabilitation services after suffering a stroke. Case manager needs to provide resources and options in which her insurance has coverage to help the patient with rehabilitation. If the patient is to be discharged just because her insurance doesn’t cover longer stay, the patient will go home with no 24/7 care. The patient has deficits from a stroke and cannot care for herself at home, her daughter can’t be there because she has a job. The deficits the patient suffered prevent her from performing daily ADL’s, going home will just make the patient decline and suffer falls or injuries. The health care system works with different payment and reimbursement models. Health care costs are very expensive, many people have health insurance provided by their jobs, other people purchase insurance on their own, while others have no insurance. There are different reimbursement models for providers, for example fee-for-service (FFS) and value-based. In the FFS model, providers are reimbursed for the number of services performed, for example an 3

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FINANCE AND ETHICS appointment, a procedure, injections, and other services provided (Tracy et al., 2023, p. 636). Value-based payment is a reimbursement for providers based on the quality of care that was provided for the patient, in this reimbursement model, the outcome of the patient is analyzed to conclude if the patient received quality services (Tracy et al., 2023, p. 636). Although the FFS model gives providers immediate payment, this model can result in fraud by providers over- charging the patients for services that weren’t needed. The value-based payment model is used which results in high quality care for patients. APN’s must be fully aware and understand the billing process to precent penalties and to provide higher quality care. The payment model that would achieve justice to patients, primary care providers, APN, and insurers is the value-based reimbursement. First, the value-based model is set to replace the FFS model to improve the quality of care a patient receives (Tracy et al., 2023, p. 636), with that said, if the FFS model will be discontinued the value-based model is the more outgoing. APN’s must focus on giving high quality care therefore billing the patients for the quality of care they gave instead of billing for the number of services. There is no point of billing the patient for many services when the quality and their health did not improve. It makes more sense to bill the patient if the care they provided helped the patient’s condition and illness. All patients, providers, APN’s, and insurers would benefit from the value-based model. Patients benefit because they receive high quality care, providers and APN’s benefit because it will bring more patients to their care, and insurers will benefit because if a patient is given high quality care, it is less likely for the patient to decline again. In the case of the video episode 3, if the patient gets discharged, she is not receiving high quality care because she is being discharged unsafe. If the patient is referred to rehabilitation which will have positive outcomes, the provider will get reimbursed for high quality care, this will benefit the provider, the patient, and insurance services. 4

FINANCE AND ETHICS In conclusion, APN’s must follow policies for where they provide services. Sometimes the policies can cause moral stress on the medical staff because they could be making medical decisions that affect the patient instead of providing high quality care. It is important to analyze the ethical dilemma and decide on a solution that will benefit the patient and the hospital. Nurses have to advocate for the best outcome for their patients. Even though the policies and laws sometimes can conflict between the right decision for the patient, nurses must advocate and seek other options involving other health care teams to provide high quality care for a patient. 5

FINANCE AND ETHICS References American Stroke Association. (2023, May 31). Rehab therapy after a stroke . www.stroke.org. https://www.stroke.org/en/life-after-stroke/stroke-rehab/rehab-therapy-after-a-stroke Daryazadeh S. (2019). Application of narrative in medical ethics. Journal of medical ethics and history of medicine , 12 , 13. https://doi.org/10.18502/jmehm.v12i13.1642 Rabber, T. (2023). Episode 3 . H5P.com. https://westcoastuniversity.h5p.com/content/1291875034789030478 Tracy, M. F., O’Grady, E. T., & Phillips, S. J. (2023). Hamric & Hanson’s Advanced Practice Nursing: An Integrative Approach (7th ed.). Elsevier. 6

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Week 3 Mid-Term

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